Chanan Meydan

Population-based trends in overweight and obesity: a comparative study of 2 148 342 Israeli male and female adolescents born 1950–1993

What is already known about this subject? Obesity is rising among children and adolescents in Israel and as a global trend. Obesity during adolescence correlates to morbidity in adulthood. Socio‐demographic and ethnic factors are risk modifiers for obesity.

Cardiovascular and Metabolic Risk Factors in Inherited Autoinflammation

CONTEXT The natural progression of metabolic abnormalities among patients with inherited autoinflammation is unclear. OBJECTIVE The objective of the study was to assess the cardiometabolic risk of participants with familial Mediterranean fever (FMF). DESIGN AND SETTING This study included nationwide cross-sectional and longitudinal cohorts. PARTICIPANTS The prevalence of components of the metabolic syndrome at age 17 years was assessed from the medical database of the Israeli Defense Force from 1973 through 1997. Included were 745 males with FMF, 902 healthy male siblings, and a control group of 787,714 participants. A prospective follow-up study traced the incidence of components of the metabolic syndrome to age 45 years among 57 FMF and 1568 control army personnel participants. INTERVENTIONS Body mass index (BMI) and blood pressure (BP) were measured at age 17 years (cross-sectional); lifestyle, anthropometric, and biochemical data were periodically recorded from age 25 years. MAIN OUTCOME MEASURES Abnormal BMI or BP (age 17 y) and Adult Treatment Panel III criteria of the metabolic syndrome were measured. RESULTS In multivariable regression analysis adjusted for known confounders of obesity, FMF participants had an odds ratio of 0.65 for the occurrence of overweight [95% confidence interval (CI) 0.44-0.96, P = .03] and 0.66 (95% CI 0.48-0.92, P = .012) for hypertension-range BP; their siblings tended to obesity (odds ratio 1.48; 95% CI 1.04-2.11, P = .008). In the follow-up arm, a multivariable analysis adjusted for age, birth year, BMI, education, socioeconomic status, ethnicity, and physical activity yielded hazard ratios of 0.32 (95% CI 0.10-0.82, P = .002) for incident obesity, 0.49 (95% CI 0.25-0.95, P = .037) for incident triglycerides 150 mg/dL or greater, 0.56 (95% CI 0.31-0.98, P = .048) for low-density lipoprotein cholesterol 130 mg/dL or greater, and 2.14 (1.368-3.359, P = .001) for high-density lipoprotein cholesterol less than 40 mg/dL for FMF participants compared with controls. Incident elevated BP was lower among FMF participants (hazard ratio 0.49; 95% CI 0.23-1.00, P = .05), whereas dysglycemia incidence was comparable. CONCLUSIONS FMF is associated with lower rates of most components of the metabolic syndrome compared with normal subjects, unlike other inflammatory conditions.

Managing the increasing shortage of acute care hospital beds in Israel

Rationale, aims and objectives Israels healthcare system has been facing increasing hospital bed shortage over the last few decades. Community-based services and shortening length of stay have helped to ease this problem, but hospitals continue to suffer from serious overload and saturation. The objective of this study is to present hospitalization trends in Israels internal medicine departments. Methods The data is based on the National Hospital Discharges database (NHDR) in the Israeli Health Ministry, pertaining to hospitalizations in all internal medicine departments nationwide between 2000 and 2012. Results Total yearly hospitalization days, representing healthcare burden, had increased by 4.2% during the study period, driven mainly by the most advanced age groups. The rate of total hospitalization days per 100,000 people for all the age groups has decreased by 17.6%, but the oldest patient group had a modest reduction in comparison (7.5%). The parameter of age correlated with length of stay and readmission rates, and neither decreased during the surveyed years. Conclusions These results demonstrated that the healthcare burden on acute internal medicine services has been reduced mostly for middle-aged populations but only modestly for elderly populations. The length of hospital stay and the readmission rates have reached and maintained a plateau in recent years, regardless of age. The findings of this study call for planning specific to elderly populations in light of changing demographics. Possible directions may include renewed emphasis on internal medicine and geriatric medicine, and efforts to shorten hospitalization time by extended utilization of multidisciplinary primary care.RATIONALE, AIMS AND OBJECTIVES Israels healthcare system has been facing increasing hospital bed shortage over the last few decades. Community-based services and shortening length of stay have helped to ease this problem, but hospitals continue to suffer from serious overload and saturation. The objective of this study is to present hospitalization trends in Israels internal medicine departments. METHODS The data is based on the National Hospital Discharges database (NHDR) in the Israeli Health Ministry, pertaining to hospitalizations in all internal medicine departments nationwide between 2000 and 2012. RESULTS Total yearly hospitalization days, representing healthcare burden, had increased by 4.2% during the study period, driven mainly by the most advanced age groups. The rate of total hospitalization days per 100,000 people for all the age groups has decreased by 17.6%, but the oldest patient group had a modest reduction in comparison (7.5%). The parameter of age correlated with length of stay and readmission rates, and neither decreased during the surveyed years. CONCLUSIONS These results demonstrated that the healthcare burden on acute internal medicine services has been reduced mostly for middle-aged populations but only modestly for elderly populations. The length of hospital stay and the readmission rates have reached and maintained a plateau in recent years, regardless of age. The findings of this study call for planning specific to elderly populations in light of changing demographics. Possible directions may include renewed emphasis on internal medicine and geriatric medicine, and efforts to shorten hospitalization time by extended utilization of multidisciplinary primary care.

Takotsubo Cardiomyopathy Induced by CT-Guided Percutaneous Biopsy of a Paraganglioma.

the osseous central canal and medial wall/boundary of the pedicle in cross section on fluoroscopy, enabling near real-time monitoring of PMMA distribution in the pedicle, which results in early detection of potential leakage into the central canal. Prior studies investigating the effectiveness of pediculoplasty used standard AP and lateral fluoroscopy projections as guidance (1–4). Martin et al (2) treated 32 consecutive patients for vertebral metastases using a beveled-tip access needle and cement delivery cannula for PMMA injection; they hypothesized that by directing the beveled tip of the cannula laterally, there would be preferred distribution of PMMA along the lateral margin of the pedicle. Although this technique may be theoretically beneficial, almost all patients undergoing pediculoplasty have either destruction of the pedicle walls or fracture clefts along the walls, which result in PMMA distribution in the least resistant pathway, potentially into the central canal. The investigators admixed barium with PMMA to follow distribution of cement under lateral projection fluoroscopy (2). This approach is similarly limited to evaluate medial/lateral leakage. In the absence of PMMA within the vertebral body, standard AP and lateral projection fluoroscopy are sufficient for accurate monitoring of PMMA distribution within the pedicle. However, patients exclusively requiring pediculoplasty are not commonly encountered. Limitations of this technique include slightly increased radiation exposure, especially in larger patients, and superimposition of osseous structures. This superimposition requires experience with fluoroscopic-guided spine procedures to accurately identify the relevant anatomy.

Molecular Regulatory Pathways Link Sepsis With Metabolic Syndrome: Non-coding RNA Elements Underlying the Sepsis/Metabolic Cross-Talk

Sepsis and metabolic syndrome (MetS) are both inflammation-related entities with high impact for human health and the consequences of concussions. Both represent imbalanced parasympathetic/cholinergic response to insulting triggers and variably uncontrolled inflammation that indicates shared upstream regulators, including short microRNAs (miRs) and long non-coding RNAs (lncRNAs). These may cross talk across multiple systems, leading to complex molecular and clinical outcomes. Notably, biomedical and RNA-sequencing based analyses both highlight new links between the acquired and inherited pathogenic, cardiac and inflammatory traits of sepsis/MetS. Those include the HOTAIR and MIAT lncRNAs and their targets, such as miR-122, −150, −155, −182, −197, −375, −608 and HLA-DRA. Implicating non-coding RNA regulators in sepsis and MetS may delineate novel high-value biomarkers and targets for intervention.